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Patients’ perspectives on how to decrease the burden of treatment: a qualitative study of HIV care in sub-Saharan Africa
  1. Viet-Thi Tran1,2,
  2. Eugene Messou3,
  3. Mariam Mama Djima3,4,
  4. Philippe Ravaud2,
  5. Didier K Ekouevi3,5
  1. 1 METHODS Team, Centre de Recherche Epidemiologie et Statistiques Sorbonne Paris Cité (CRESS UMR 1153), Paris, France
  2. 2 Centre d’Epidémiologie Clinique–Hôpital Hôtel-Dieu, Assistance Publique–Hopitaux de Paris, Paris, France
  3. 3 Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d’Ivoire
  4. 4 Institut Pasteur de Cote d’Ivoire, Abidjan, Côte d’Ivoire
  5. 5 Bordeaux Population Health (UMR1219), INSERM, Bordeaux, France
  1. Correspondence to Dr Viet-Thi Tran, Centre de Recherche Epidemiologie et Statistiques Sorbonne Paris Cité (CRESS UMR 1153), Paris 75004, France; thi.tran-viet{at}


Objective Patients living with HIV infection (PLWH) in sub-Saharan Africa face an important burden of treatment related to everything they do to take care of their health: doctor visits, tests, regular refills, travels, and so on. In this study, we involved PLWH in proposing ideas on how to decrease their burden of treatment and assessed to what extent these propositions could be implemented in care.

Methods Adult PLWH recruited in three HIV care centres in Côte d’Ivoire participated in qualitative interviews starting with ‘What do you believe are the most important things to change in your care to improve your burden of treatment?’ Two independent investigators conducted a thematic analysis to identify and classify patients' propositions to decrease their burden of treatment. A group of experts involving patients, health professionals, hospital leaders and policymakers evaluated each patient proposition to assess its feasibility.

Results Between February and April 2017, 326 participants shared 748 ideas to decrease their burden of treatment. These ideas were grouped into 59 unique patient propositions to improve their personal care and the organisation of their hospital or clinic and/or the health system. Experts considered that 27 (46%), 19 (32%) and 13 (22%) of patients' propositions were easy, moderate and difficult, respectively, to implement. A total of 118 (36%) participants offered at least one proposition considered easily implementable by our experts.

Conclusion Asking PLWH in sub-Saharan Africa about how their care could be improved led to identifying meaningful propositions. According to experts, half of the ideas identified could be implemented easily at low cost for minimally disruptive HIV care.

  • burden of treatment
  • Sub-Saharan Africa
  • patient empowerment

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  • Contributors Generated the idea: VTT. Conceived and designed the study: VTT, EM, MMD, PR and DKE. Collected the data: Meliane Lorng and Daniel Balfong under the supervision of VTT and EM. Analysed the data: VTT, Alexandra Anderson. Wrote the first draft of the manuscript: VTT and PR. Contributed to the writing of the manuscript: VTT, PR and DKE. ICMJE criteria for authorship read and met: VTT, EM, MMD, PR and DKE. Agree with manuscript results and conclusions: VTT, EM, MMD, PR and DKE. DKE is the guarantor, had full access to the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This work was supported by the French National Agency for Research on HIV and Viral Hepatitis (Agence Nationale de Recherche sur le Sida et les Hépatites Virales–ANRS) (Grant No 12365) and the "Fondation pour la Recherche Médicale" (Grant No 40284).

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval National Ethics Committee from the Ministry of Health of Côte d’Ivoire.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from the study are available upon request to the authors.

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